Care Leavers and Health CLA – a paper from 2017

It is well known that care leavers experience disproportionately more disadvantage than the general population. And we know in what areas this is likely to manifest itself: education, housing, finance, criminal justice, self-esteem, health etc More often than not there is some acknowledgement of the effects of this disadvantage but very little being done to reduce it.. Three years ago The Care Leavers Association set about looking more closely at the area of health disadvantage. We wanted to get a better understanding of the health needs of care leavers and to try and develop ways in which agencies could better respond to these needs.

So we established our project Caring For Better Health. Our starting point was to approach the issue from various angles: understand the current research; talk to care leavers about their experiences; talk to practitioners; understand the needs of commissioners. The end point would be to bring this all together in a research report with recommendations for service improvement. Along with way we would also develop useful resources for different audiences.

Our starting point was the current research. This proved to be challenging yet insightful. Yes it’s fair to say that there is not a huge amount of direct research on care leavers and health. However there is a good body of work even if the sample sizes tend be low. And on top of this there is definitely a lot of research in relation to looked after children and health. Using various search phrases on a university based database we downloaded over 100 research publications that asked some questions about health to either looked after children or care leavers. The main surprise? Just how much of the research was in agreement – looked after children and care leavers experience a range
of negative physical and mental health issues. What’s really frustrating is that given the fact that 95% of the research is saying the same thing you would think the government and other organisations would have come together to develop a positive response. But that has not been the

We then decided to ask care leavers themselves about their experiences to see if it responded to the literature review. We developed a survey which asked over 50 questions related to both physical and mental health. For some of the key issues we asked people to score their responses in relation to before care, during care and after care. The survey was open for 3 months and we distributed widely throughout our networks. We received 417 responses which is one of the largest pieces of research with care leavers of all ages.70% were female, 30% male. 32% were under 25, 52% 26-60 and 14% over 60. Only 10% were from a non-white background. Roughly 30% each went to residential and foster care with 60% going to both. Here are some of the top level findings for those experiencing some, often or all of the time

 87% of people experienced feelings of low self esteem

 79% of people experienced feelings of anxiety

 76% of people experienced feeling depressed

 78% of people experienced feelings of isolation

 25% of people were using recreational drugs in care

 54% of people felt their mental health issues were as a result of their time in care

 20% of people felt their physical health issues were as a result of their time in care

However it was in the sections where we asked people to describe their experiences that we received the most difficult of responses. Some included:

“Being in care made me have more problems to deal with, not less.”

“I was raised in an abusive foster family. I self-harmed in care and out of it, leading to admission to mental health facilities. I had ongoing mental health problems until I set about finding ways to help myself.”

“I think I’ve probably lived with some sort of depression for most of my life, due in large part to my childhood having been spent in care.”

“I often felt undermined and not listened to, which made me feel a lack of control and fed my anxiety and panic attacks”

“I think being in care has negatively impacted me, made any feelings I had a lot worse, isolated and unloved”

“I’ve always felt isolated within my foster home, and I think this may have contributed to my low self-esteem and unwillingness to be around people or to meet new people.”

Now we are not saying that all care leavers experience negative mental and physical health – this is just not the case. Yes it was a self-selecting survey so we would expect more respondents to be talking about negative things. However it corresponds to the winder literature.

There is a large proportion of care leavers who do not experience good health and wellbeing. Some of these issues may be related to the reasons for entry into care and some of them may be related to the actual experience of being in care. For whilst the care system is well intentioned, it can also cause harm. A lack of emotional bond with carers, frequent placement moves, not being listed too, treating me different to “normal kids”, not being given a chance to talk about my past, not being given enough love, care and attention, these are all situations described by care leavers which can have serious implications for mental health especially they are continually repeated and reinforced over a period of time.

And things don’t always get any better when care leavers are trying to forge their way through life as adults. No one cares about you, totally on your own, all support disappears, not given skills (practical, emotional etc), had to wait months to be seen so I gave up, couldn’t relate to people because of care experience, I had to take drastic actions before I saw someone / got help – these are some of the experiences of people in the leaving care process. And again the repeated nature of these issues means that they can build and build until something breaks.

But generally, when it breaks it’s not seen as serious enough. Too many care leavers do not fit the criteria to access mental health services and so are left with no support. Yet the issues are real. The reality is harsh. And it’s not just mental health. Recent research has shown that exposure to trauma during childhood significantly increases the likelihood of physical illness.

So what needs to change? Well we need to improve the processes involved in the care system and make the care placement as supportive and loving for a young person as possible. We have to provide opportunities for the young person to grow. We need to help young people in care and care leavers to understand themselves and communicate well with others. And we must listen to them.

In essence there needs to be an understanding that the whole care experience can have an effect on a young person’s health and wellbeing. We have to plan to get it right. And where there are negative health issues then we need to provide the right support at the right time. And the support needs to be provided not just to those leaving care but to adult care leavers of any age. There needs to be a number of systemic and service related changes made to improve things for care leavers. We don’t promise to have all the answers, but we aim to publish our final report in June/July – so look out for it.

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